Kisa A Pentarek
Individual provider Active NPI Professional Counselor · Everson, PA
NPI 1497426142 · NPPES record last updated Sep 22, 2021
Key facts
- NPI
- 1497426142
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- PC013680 (PA)
- Practice address
- 329 Brown St
Everson, PA 15631-1001 - Phone
- (724) 757-4123
- NPI assigned
- Sep 22, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC013680 | PA | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC013680 | PA | Yes |
Addresses
Primary practice location
329 Brown St
Everson, PA 15631-1001
Mailing address
PO Box 121
Everson, PA 15631-0121
Phone (724) 757-4123
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.